South Carolina Department of Mental Health

Toward Local Care
From Institution to Community
Updated 05/13/13

TLC Philosophy

People who have a serious mental illness do better clinically when treated in the community rather than living in state mental hospitals. They get better faster and stay better longer when they receive services in their community, if these programs meet their needs and are well organized and easily available. The closeness of family, friends, and community support aids in their recovery process.

The South Carolina Department of Mental Health is committed to enhancing treatment in the community by developing community programs that provide residential and rehabilitative services to help clients integrate into their communities, while properly addressing clinical needs and the safety of the client and the community, and providing stabilization services that assist individuals in distress without hospitalization.

The agency is fulfilling this commitment through a system-wide initiative called Toward Local Care, or TLC.

TLC Goals

  • Assist clients in transition from inpatient institutions into the community
  • Help clients remain in the community and avoid rehospitalization 
  • Facilitate downsizing of the agency's long term psychiatric facilities
  • Reduce acute care psychiatric admissions
  • Decrease cost of psychiatric care to agency

To reach these goals, staff encourage clients and their families to involve themselves at the level of intensity they wish in all phases of treatment, service planning and implementation.

Palmetto treeWe'll do whatever
it takes to support the
client's efforts to
 remain
in the community.

Client Outcomes

  • increase level of independence and perceived quality of life.
  • decrease reliance on hospital system
  • manage crisis without psychiatric hospitalization

TLC Program Components

Since initiating TLC in 1992, the Department has funded statewide programs providing creative treatment approaches. TLC community-based programs have a dual focus on clients in long-term hospitals, have multiple hospitalizations and/or clients in the community who are at risk of becoming hospitalized in an acute psychiatric facility.

TLC programs are located in rural and urban areas, have staff sizes ranging from 1 to 10, serve a range of 5 to 160 clients, and have a common service model element of combined intensive individualized services with residential options.

TLC Program Criteria

Criteria for eligibility for a TLC program is any individual with a hospital stay of 90 days or more or three or more psychiatric hospitalizations within the last year. 

SCDMH clients must have a primary diagnosis of a serious mental illness, be at least 18 years of age, and agree to participate in the program. Clients who are living in a community residential care facility may also be considered to achieve the goal of greater independence. Clients' physical health will be considered to the extent that he/she does not have a serious untreated medical need. Clients' in need of licensed nursing care or nursing home level of care are not eligible for current TLC programs.

TLC Residential and Treatment Options

Mental Health Centers have varying types of programs and services which may include one or multiple options.¬† ¬†Programs use a case management team comprised of many different professionals such as a psychiatrist, masters level case manager, licensed registered nurse, mental health counselors and support staff, who have an intensive outreach philosophy. Treatment consists of individual counseling, group therapy, living skills, skill building activities to increase independence, and educational and vocational pursuits. Traditional services provided by local mental health centers are available for all clients. Medical and dental services are arranged for based on individual needs.

Mental Health Centers have varying types of residential programs which may include one or more of below models:

Homeshare (Adult Foster Care )

A living arrangement in a community household other than with natural family members. The home is owned or rented by the Homeshare provider. One client for whom the provider receives reimbursement for expenses, lives as a member of the household. Providers are screened, trained, and participate in monthly Homeshare provider support meetings. Respite services are available for providers.

Homeshare programs are available in the following mental health centers:

  • AIKEN-BARNWELL
  • BECKMAN
  • BERKELEY
  • CHARLESTON-DORCHESTER
  • COASTAL (Beaufort)
  • COLUMBIA
  • LEXINGTON
  • ORANGEBURG
  • PEE DEE
  • SANTEE-WATEREE
  • TRI-COUNTY
  • WACCAMAW (Horry, Georgetown and Williamsburg Co.)

Supervised Apartments

A living arrangement in a community apartment complex with mental health center staff on site or with mental health staff available. Clients live alone or with a roommate in an apartment, and are supported by intensive/outreach case management services.

Supervised/Supported apartments are available in the following MHC:

  • AIKEN-BARNWELL
  • AOP
  • CATAWBA-CHESTER CO.
  • CATAWBA-YORK CO.
  • COLUMBIA
  • COLUMBIA
  • GREENVILLE
  • LEXINGTON
  • ORANGEBURG
  • PEE DEE
  • SPARTANBURG
  • TRI-COUNTY
  • PIEDMONT
  • WACCAMAW

Intensive Residential Programs (IRP)

A group living arrangement for a maximum of 16 residents and managed by the local mental health center. Center staff are on site 24 hours a day to provide structured and intensive programming that meets client needs.

This type of residential program is available in the following MHC:

  • LEXINGTON
  • PIEDMONT
  • SANTEE-WATEREE

Mixed Residential Programs

In addition to the above residential options, the following traditional options are available:

  • Community Residential Care Facilities
  • A group living arrangement licensed by DHEC and under a MOA with the mental health center. Center staff is available.

  • Intensive Case Management Teams

    An assertive outreach treatment approach to clients in frequent crisis, or high recidivist who use the system for psychiatric or situational distress. The following Community Mental Health Centers have this program:

    • AIKEN-BARNWELL
    • CATAWBA
    • CHARLESTON
    • GREENVILLE
    • PIEDMONT

  • Independent/Family
    Clients living alone, with a roommate or family in a private home, apartment, or rooming house. This residential option is available only after clients have made the transition through the programs listed above. However, these clients still require the intensive/outreach case management of the TLC staff.

Success

After entering Toward Local Care programs, clients experienced:

  • 91 percent reduction in the average number of admissions per year
  • 92 percent reduction in the number of days per admission statistically significant improvement (p < 0.001) in client perception of quality of life

Future

The future is bright for South Carolina's transition toward local care.

TLC programs are continually expanding to provide mental health services that address psychological, residential, financial, educational and vocational needs. SCDMH recognizes the benefits TLC programs offer in providing client centered treatment and promoting individual recovery.

For information on TLC, contact:

Mallory Miller, LMSW
S.C. Department of Mental Health

Community Mental Health Services
P.O. Box 485
Columbia, S.C., 29202
803-898-3035

For information on employment, contact:

S.C. Department of Mental Health
Division of Human Resource Services
P.O. Box 485 Columbia, S.C. 29202
803-898-8595